Effect of radiofrequency ablation with chemical neurolysis of lumbar sympathetic ganglion in ischemic limb pain with diabetes mellitus: a randomized control trial

Abstract

Background:Ischemic limb of peripheral arterial disease with diabetes is a worse comorbid condition affecting the lower limb. The debilitating presentation of ischemic limb include pain, ulceration, impaired ulcer healing which leads to amputation of lower limb. Its treatment includes pharmacological approaches, glycemic control, lumbar sympathectomy, endovascular therapy, revascularization. The minimally interventional treatment strategy includes lumbar sympathectomy by radiofrequency ablation with chemical neurolysis. Our objective is to evaluate the effect of lumbar sympathectomy.

Methods: This randomized clinical trial was conducted at the department of Anesthesiology SICU & Pain Medicine, BIRDEM General Hospital. Before commencement of the study formal ethical clearance and informed consent was taken. Diagnosis of ischemic limb was made on clinical grounds and colour doppler study. Total 52 diabetic patients with ischemic limb were included in this study and randomly divided into two groups (26 patients in each group). Total 26 patients (control group) received conservative treatment (group-A) and 26 patients received radiofrequency ablation with chemical neurolysis of lumbar sympathetic ganglion (group-B). Data obtained were improvement in rest pain (visual analog scale), temperature, capillary refill time, progression of ulcer healing, reduction in dose of drugs, need of debridement or amputation was measured at 0 day, 1st week, 2 nd week, 1st month and 3rd month. Following data collection, data were analyzed by the SPSS 24.

Results: Demographic characteristics were similar across the two groups in terms of age, sex, site of the procedure (p>0.05 in all cases). Pain intensity observed in immediately after procedure, 1st, 2nd week, 1st & 3rd month. Improvement in rest pain significantly decreased in group B compared to group A (p<0.001). Mean VAS at 3 rd month was 0.7 in group B. Mean capillary refill time decreased in group B to 3.3 sec in comparison to another group (p<0.001). Post treatment increase in skin temperature was significant in group B (p<0.001), mean increase was 1.9°c. Dose of amitriptyline, tramadol, pregabalin and paracetamol significantly decreased in group B compared to group A (p<0.001). Line of demarcation appeared in 80% participants within 3 months in group B and need for post treatment amputation reduced in group B significantly in comparison to group A (p=0.008).

Conclusion: Radiofrequency ablation with chemical neurolysis of lumbar sympathetic ganglion is a potential treatment modality for lower limb ischemia.

BIRDEM Med J 2026; 16(2): 70-79